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Multi-day tips, part 1: How to avoid BLISTERS!

Smarana Puntigam has been running multiday races for over 20 years, including the 3100 mile race eight times. This is the first of a series of articles on dealing with common issues that crop up during multiday races...

How to avoid blisters? - that is a big one for a multiday runner. If you do shorter races, blisters are inconvenient, but easy to deal with because you do not have to run on them the next day. However, once you have blisters in a multiday event they can really influence your performance a great deal. Depending on the area the blisters appear in, and whether they get inflamed, the range of pain goes from hardly-felt to “I think I have to stop, I just can not take the pain.“ So, the best thing is always to prevent blisters in the first place.

Here are the main issues to deal with:

1. Wet feet

One of the most important things is to keep your feet dry - if there is a lot of moisture, the skin gets very sensitive and prone to blisters.

Powdering your feet several times a day with foot powder or baby powder can help you to reduce the friction in the shoes and to keep your feet dry. There are also excellent crèmes that keep the feet soft, elastic and reduce also the friction. Vaseline is not so good, because it does not allow the feet to breathe and I always feel that my feet are sliding around too much inside the shoes. However from my experience if the race is longer than a day, powder is the way to go.

There are runners whose feet simply sweat more than others, and who will always have wet feet. Many runners cut open their shoes to let the steam and heat out of their shoes.

2. Choose your socks wisely

The big variety of socks is sometimes confusing - there is such a big selection of socks, each promising their own special feature.

Don't use cotton socks - they get soaked with sweat and moisture, which does not go away. This was one of my main problems when I started ultra-running and that is why I got a lot of blisters. Dipali Cunningham, one of the leading female multi-day runners, was shocked when she saw me showing up for my first 700 miles race with cotton socks, and gave me valuable information in this regard.

Use socks that are not too thick and are made of a fabric that does not store water (i.e. coolmax). For example Nirbhasa Magee, who ran the 3100 Mile race in 2015 and 2017, is very fond of WrightSocks, a thin sock with a double layer - this means the layers of the scok rub against each other rather than the skin.

3. Ill-fitting and narrow shoes

Cutting to avoid an upcoming blister on the side of the foot, just below the toe
Don't take new shoes for marathons or long distances; it takes some time for the shoes to get the right shape for your feet. They have to get used to one another. The shoe size should be at least one number bigger than the size of your foot, with plenty of room in the toebox so your toes don't rub against the front.

When you are running ultra distances your feet keep swelling, and you may need extra wide shoes. The first day you can still run in your usual running shoe, but as the race progresses, your feet keep changing. A shoe that perfectly fits on the morning of the third day of a multi-day rice, might not fit any more in the evening.

Also you may need a different insole, or to cut the one you have. The insoles that come with the shoes are not flat in the heel area, but have edges that bend upwards. As your foot swells, the heel doesn't fit any more into the area of the insole and the edges of the insole can cut into the heel and sides of the foot, creating blisters.

Blisters or potential blisters on the toes or sides of the feet might be alleviated by cutting away the part of the shoe that is rubbing against it, as long as it does not affect the shoe's stability. You will probably need to cut down all the way to where the top of the shoe joins the sole to remove the friction.

4. Hot feet

Where there is friction, there is heat.

Some use creams to reduce the friction, but on the long run from my experience powder is the way to go, since it keeps the feet dry and reduces the friction.

Again, cutting your shoes reduces heat as well as friction.

There are creams that help to cool down your feet. The skin absorbs the cream, so that you can take powder after some time.

During breaks, you can put your feet into a plastic bag and put them into ice water to cool them down and reduce the swelling.

Changing your socks and shoes frequently will help to air the feet and get rid of moisture and heat.

5. Taping 'hot spots' and callouses

As a runner you most probably know your 'hot spots' - areas of the feet that very easily turn hot or red during a run. If you don't know them yet, check your feet after a longer run and try to locate them. Once you do know them tape them before ultra runs. You can use paper tape or very thin tape, but do not use kinesiology tape - it creates a lot of heat and you will get blisters right there.

If there is a callous - very often in the heel section - take it away with simple sand paper or special tools from the drug store. When the feet start to swell during multi-day runs, the normal skin is elastic and can expand, while the callous cannot. Spots like that are predestined for blisters.

Multi-day running tips - more articles

Multi-day tips, part 4: What to do about blisters when you get them

Nearly every runner has had the experience of blisters - who really wants to befriend them, but what can you do when they show up? In my years of running I had to deal a lot with liquid filled bubbles on my feet, especially when I embarked into the ultra-running world.

If you run a 10 km race or a Marathon and you get these little or large beasts, you can endure them, rest afterwards and give them time to heal; but once you have embarked into ultra-running, you have to find a way to run on blisters. Some people are very fortunate and they hardly get any blisters, while others are smart and take care of their feet. I had to learn it the hard way; much can be done with prevention. (We discussed how to avoid blisters here.)

Dealing with blisters

The main way of dealing with blisters is draining it, disinfecting it, and dressing it.

Draining: I personally like to pop the blister with a needle and then squeeze it. Pulling the needle with a thread through your blister to drain it is also a very popular solution.

Disinfecting: The traditional way is to use iodine for disinfection, but I prefer tea tree oil. It is natural, is very strong, it dries the blister, plus has a tremendous effect on pus. A blister that is filled with yellow-white liquid is a serious problem, and tea tree oil reacts with pus and heals it. One disadvantage from the oil is its smell, that is very intense and not everybody likes it. Lavender can also be used with the additional benefit of faster healing of the skin and a very pleasant smell. Again there is DMSO cream, a very strong disinfectant that also helps the healing process.

During the 3100 Mile Race in 2017, I had quite a lot of blisters - fortunately I had a helper, Horst, who knows everything there is to know about treating them! Here he is using a combination of ribwort and paper tape.

Dressing:
1) Second Skin: a rather ambivalent solution as far as I am concerned. If it is just for a day it is fine, but if the race goes on for days, it slows down the healing process considerably. Since the broken blister is always kept wet with the second skin, it can hardly heal. If you do use it, it should be fixed with paper tape.

Ribwort

2) Instead of second skin I have also used paper tape, or ribwort and paper tape. Ribwort grows as a weed pretty much everywhere, even in urban areas. You pluck it fresh, wash it and put it with the smooth side on the skin, after a few hours you can change it. This herb is also anti-inflamatory.

3) Special blister sticking-plasters are getting more and more popular. You cut the skin from the blister and stick the plaster on top of it. You keep it on the blister until the skin is healed. Again from my personal experience, I would not recommend it for a multi-day race, since it can create heat through friction and even worsen the problem.

4) If the blister is really painful and not too big, you can cut a hole into a soft material and fix it to your foot with paper tape, placing the hole over the blister (see picture). This might stop the blister from rubbing against the shoe, as the pressure is now on the adjoining areas.

5) Sheep wool is very useful as an extra cushion on top of the paper tape, to take pressure and friction away from the blister. It is also usefull for hot spots or areas where there is pressure in your shoe.

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Multi-day tips part 5: An equipment checklist

Here is a suggested checklist for an ultra race - This is of course not a complete list, but a selection of helpful items. The links below go to suggested pages on Amazon (this is where we ordered them and as such it might be helpful to you)

Helpers - as a rule of thumb, a good helper can save you anywhere from 2 to 4 miles every day during a multi day race. If you are starting for the first time, it is definitely wise to get helpers who have either done multidays before, or have proved themselves in helping others.

Phone + charger: If you are doing a longer multiday, talking to your friends and family is a really good way to keep you cheered up. If you are travelling abroad, make sure you dont skimp on the phone plan, and that it is sufficient to let you call whoever you need to call, even if it is half way around the world.

Money

Earplugs You may be sharing your sleeping quarters, and earplugs can be of great help if your neighbour is snoring

Sun lotion If you are exposed to the sun the whole day, you need a proper protection factor, factor 30 or higher. For longer multidays, .

Caps to deal with different weather. At least two caps for change and if the sun is beating down all day, it is advisable to have also a cap with neck protection, as the neck is predestined to get over exposed to the sun and here many important nerves run through. Those who get a sunstroke know that you barely can stand on your own feet, let alone run well. You feel a sunstroke even the following day. One such hat can be found here.

Clothing: The amount of trousers, socks, t-shirts etc depends of course on the length of the race.
- For a 6 day race I would recommend six trousers, 12 t-shirts, two rain jackets, 12 pairs of socks and three pair running shoes.
- For a 3100 Mile race, compression shorts which might help for chafing

Orthopaedic Inserts: It may happen that the long arch drops after days of running. Therefore it's good to have a support for the middle part of the foot or for the front arch. It's advisable to test the inlays in the training to avoid pressure points in the race. Personally I cannot use inserts, because I get blisters in the front arch, therefore I use metatarsal pillows, which I can stick in the shoe and support the long arch.

Rainclothes and umbrella: An umbrella can be of true help in case of heavy rain. Best to have both a small and bigger umbrella.

Sunglasses

Mp3 player/ipod - it is good to have more than one, and keep the other one charged.

Supplements and medicines: As you do more races, you will find out what works for you. It is also very useful to test supplements in training. I found out that the following food supplements are important for me.
- Iron, Magnesium, Calcium and a multivitamin compound with a big dose of vitamin C - these supplements should be as much as possible from natural origins.
- I would like also to point out Arnika in homeopathic form. In grade D4 or also C30 it helps to relax the muscles during running, and is also helpful to reduce swellings in the legs. If you sprain your ankle, Arnika is the best choice.

Lotions: Vaseline is good as ointment for friction areas, once these areas are irritated Vaseline must be avoided. There you should use a calendula lotion to alleviate the irritation, a true blessing with healing effects. Horsebalm for the foot are a true refreshment and the feet are pleasantly fresh.